Q: Dr. Crapo: In the past five years I’ve had some serious problems with my teeth. First, I had swelling and terrible pain with my lower front teeth. I had to have root canals and one extraction. I can tell you when the infection was being brought under control, I was in pain. The other thing that bothered me was that the dentist, though kind, was persistent in making me clean the area. He showed me how I wasn’t doing a good job and if I did my situation would improve. At first, I was mad because I did brush my teeth, so I thought this dental problem wasn’t my fault. It took six months before I got it. I was a bigger part than I wanted to admit but I finally had it under control. If I knew then and even before, I’m sure I’d still have all my teeth. Two years went by and I started to have pain on my lower left side. My dentist told me that there was trouble but I didn’t want more dental bills or involvement so I put it off. Well, it finally started to hurt, so I asked him what I should do. He gave me three or four options. He said I had one tooth that should come out, in fact he said I’d let it go too long and now I should have two teeth out. I asked him if there was any way in the world he could save my teeth. He told me I needed to have one root canaled and one of the roots cut out of the same tooth because it couldn’t be saved. The other one had a failing root canal and he said it’d have to be redone. “Best to have implants” he said but I’m not sure. What is best? I’m still undecided.
A: Root canal therapy and root resection done well, is still very good therapy. Bridging teeth is still excellent dentistry when it’s well done and well cared for. If you are in your sixties or seventies or beyond, the implant solution is best because it’s easier to clean and not subject to decay. Your history suggests implants may be best for cleaning and future decay. As we get older, our salivary output decreases and our mouth is drier – add medications to the mix and we have a greater possibility for decay even under a bridge.
Having said that, I realize people are very attached to their teeth (pun intended) and want to keep them, as you’ve indicated. If the job can be well done and if you will promise to see your dentist and the hygienist every three months to ensure you’re cleaning properly, you may well find your choice the best for you. It’s a value judgement and you’re in control.